Neuro shield
Editorial

Helmets Don't Prevent Concussions - But This Tech Might..

Words Cam McRae
Date Oct 25, 2017

I can't even remember the last time I had a concussion. Hopefully it wasn't recently... Seriously though I've bonked my noggin more times than I care to admit and I have actually stopped counting. 

I got bucked and over shot the last jump in the Whistler biker cross course in 2001 and landed on... I assume it was my head. The last thing I remember was thinking "oh shit..." I apparently spent the next five hours asking two questions of my friend repeatedly; "what happened?" and "What's wrong with my lip?" I could push my tongue through the gaping hole in my face so my curiosity was understandable. All I recall is 'coming to' while walking with my buddies back to my hotel room in the Whistler Village about five hours after my perfectly executed lawn dart. 

I was cloudy and plagued with confusion (worse than usual) and headaches for almost six months afterwards, but a much less severe bang kept me off the bike for over a year more recently. It's a frustrating injury and realizing there may be long term consequences makes brain injury somewhat disconcerting. 

But we keep strapping on our helmets. Righteous motorists scold riders without brain buckets, despite going lidless themselves, but it turns out that most protective headwear designed for sport does little to protect your brain from concussion. Intuitively we think we are safer, and hardshell headgear does an effective job at preventing skull fractures and contusions when impacts are relatively low energy, but that's not what causes concussion.

Helmet manufacturers probably don't want you to know that you can sustain a concussion without any head impact at all. And in these cases it's possible that increased mass on your gigantic head could increase the odds of a brain injury. It's thought that concussion is caused when our brain, which is normally protected by cerebrospinal fluid, makes contact with the inside of your head bone. That cushion of fluid isn't enough to prevent your grey matter from sloshing around once an impact surpasses a certain threshold. And by threshold I mean a personal threshold that may even be variable. Studies have suggested that sometimes a less severe impact, even in the same location, can produce a more severe injury than a harder hit. 

The bowl of boiled worms that controls everything we do, consciously and otherwise, is one of the most fragile tissue masses we possess. Your neighbourhood neurosurgeon will tell you that your cerebrum is the consistency Jello-O and on impact it bends and stretches and gets twisted out of shape. 

Most of us likely wear helmets to prevent concussions and manufacturers are keen to have us believe they are effective, without ever stating that in their marketing literature. Recent developments, like MIPS and similar technologies aimed at reducing rotational force are focussed squarely on preventing concussions, but hard evidence that proves the effectiveness of these systems does not exist. Research does suggest that rotational forces may play a significant role in brain injury, so these add ons don't seem like a bad idea at all, but we are a long way from knowing how effective they are.

Neuro Shield

Bauer's Neuroshield is a $200 hunk of plastic that hasn't yet caused blood clots and may have prevented some brain injury. More info here. The U.S. version, the Q Collar, using identical technology from Q30 Innovations, hasn't yet received regulatory approval stateside but is available in Europe.

Just as an aside, while some of you are preparing your scathing, bitter retorts, I want to make it clear that I am not suggesting you shouldn't wear a helmet. I wear one myself. When walking to the bathroom. Helmets aren't perfect but they are all we have for the moment. So feel free to fry me for any number of other crimes, but not the one I am not committing. 

There may be some hope, however. Not necessarily for mountain bikers at this point, but for those who sustain hundreds of lower energy impacts like hockey or football players. Research has revealed that male bighorn sheep and woodpeckers avoid sustaining traumatic brain injury by increasing inter-cranial pressure before crushing their skulls into hard objects. They sustain brutal impacts, apparently without so much as a mild brain cramp. This gave researchers an idea.

Two products have recently come to market that aim to increase pressure in the cranial vault - our brain's garage - by increasing blood volume in the veins that surround your brain. It's thought that a slight increase in pressure may prevent your brain from contacting the skull in low energy impacts. And the originators present compelling evidence after having high school hockey players wear the device for a season. 



The first study involving athletes used a high school hockey team and advanced imaging techniques to compare pre- and mid-season changes to white matter structure in the brain. In half a season of play, each athlete received an average of 190 impacts over 20g, with an average impact level of 38g. As shown with diffusion tensor imaging (DTI), athletes not wearing the collar showed statistically significant changes in white matter microstructure of the brain, while athletes wearing the collar showed no significant changes despite similar levels in accumulated accelerations from head impacts.

You can read the entire study here. Were they paid by anyone involved with NeuroShield? Possibly, but we have no evidence of that. Is the study accurate? I skipped statistics and scientific method in University so I'm the wrong guy to ask, but the results they are pushing are impressive.

Sadly this isn't likely to be much good to mountain bikers. The impacts we sustain are far less frequent (unless you are a dirt jumper or bmxer) but often much more severe and it's unclear whether either of these devices will mitigate injury when the Gs get nastier. At the same time, any progress in this area is cause for optimism. It's heartening to know that some of us may be able to string several two syllable words into sentences when we reach age 65. 

Trending on NSMB

Comments

slimshady76
+1 JT
Luix  - Oct. 25, 2017, 4:41 a.m.

So it's like a cock ring, but for your other head?

BTW: the neuroshield site isn't working, at least at the time I'm writing this comment.

Reply

xy9ine
0 Merwinn dddd
Perry Schebel  - Oct. 25, 2017, 6:43 a.m.

^i giggled. can i just wear a snug turtleneck instead? it's high time they came back into fashion.

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cooperquinn
0
Cooper Quinn  - Oct. 25, 2017, 9:09 a.m.

So... you can't prove a negative, so I'm asking the impossible. 

But is there some kind of reference for this, "hard evidence that proves the effectiveness of these systems does not exist. "

i.e. are there studies that show..... that these techs make no difference? Are you telling me its entirely marketing wank? 

Or is there just no studies that show they DO work?

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redbarn
0
redbarn  - Oct. 25, 2017, 10:08 a.m.

https://www.youtube.com/watch?v=oIS5n9Oyzsc

Sorry, not sorry.

Cool research, although how about we keep working on helmets that do a better job preventing concussions...

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cam@nsmb.com
0
Cam McRae  - Oct. 25, 2017, 10:39 a.m.

It's hard to imagine a helmet preventing a concussion that doesn't involve an impact to your head. This may sound like an unusual case but I have had that happen. And how do we prevent our brain from sloshing around our cranial cavity? (the Neuroshield is only effective against low intensity impacts so that doesn't appear to be the solution. It's possible that working on a helmet that prevents concussions is like perfecting on a jockstrap that prevents heart disease.

Also - LOVE the Turbo Encabulator. Chrysler's use of prefabulated amulite was years ahead of the competition. Thanks for sharing that.

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redbarn
0
redbarn  - Oct. 25, 2017, 11:01 a.m.

:)

Yeah, we're limited to preventing injury that arises from a helmeted head impact. But that doesn't mean that concussion prevention/reduction can't be improved there, and demonstrably...

This tech is still really interesting, especially when considered as a "belt & suspenders" approach in conjunction with good helmet/protective equipment design.

Reply

mhaager2
+5 Cam McRae natbrown Mammal Pete Roggeman dddd
Moritz Haager  - Oct. 25, 2017, 10:17 a.m.

As someone who has sustained seven concussions, and as a practicing Emergency Physician I feel like I can comment on this from both sides of the fence. Your (lack of) recollection of your Whistler accident  sounds nearly identical to my last injury though I was snowboarding, and made me  laugh.  

Firstly this is an excellent article. I was particularly impressed with your ability explain some fairly complicated concepts in easy to follow language without losing essential information. I can address your questions about the validity of the study. In short it's a pilot study that should trigger further research. I would not rush out to buy a collar based on this just yet, though it does look promising. Things they need to do is trials with a lot more subjects in it to lessen the chances of getting statistical errors and linking it to clinical outcomes i.e. in this study they looked at a bunch of stuff they think correlates with concussion risk but now they need to prove it actually prevents clinically diagnosed concussions. What would be interesting to me is if a collar that detected or anticipated impact somehow (accelerometer based maybe) and in response applied pressure only at that time might be more effective, or at least better tolerated (there was a high drop out rate in this study of people not wanting to wear the collar).

The area of traumatic brain injury is difficult to study because of ethical constraints as well as the variability in the way concussions can present.  They are not always as easy to diagnose as Cam's above experience that pretty much everyone can agree on. As an interesting aside  I have never jumped on the full face band wagon. While it makes sense that they might prevent facial smash injuries, I always wondered/worried that the jaw bar might actually act as a lever and increase the risk of breaking your neck. Just to be clear I HAVE NO EVIDENCE to support that theory. Last time I searched the medical literature (10 yrs ago) I could not find anything that answers this question one way or the other. Maybe there is something out there now on it.

In terms of should you wear a helmet, YES ABSOLUTELY! While they don't seem to effectively prevent concussions, they do prevent other complications like death (no I'm not being dramatic here) so it's a no-brainer (sorry, couldn't resist). 

Great to see NSMB covering this issue.

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andy-eunson
0
Andy Eunson  - Oct. 25, 2017, 2:24 p.m.

My wife ski raced at a very high level including World Cups. The skiers used full face helmets for DH back in the 80's although just bolt on one side from my recollection. They stopped using them because it was thought that the jaw piece could catch in snow during a fall and cause neck injuries. Snow and the mechanics of a high speed fall on that type of surface is different than a typical mountain bike scenario. I am not aware of any mountain bike or motocross accident where a jaw piece caused a neck injury. Dual purpose for motocross though as a jaw piece also protects from roost. They used to wear mouth guards for that before full face.

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cam@nsmb.com
0
Cam McRae  - Feb. 20, 2019, 11:56 p.m.

There was a young lad who sustained a spinal injury on the Shore 15 years ago or so and it was thought that the jaw piece contributed or even caused his injury. This is clearly impossible to prove but enough to give pause.

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AJ_Barlas
0
AJ Barlas  - Feb. 25, 2019, 6:53 p.m.

Wow. Completely possible. Helmet designers have been concerned about the forces generated from a GoPro attached to a helmet, so the jaw piece could cause similar issues. Oddly, I've never considered that before (but have with cameras)!

Reply

Keit
+1 Cam McRae
Keit  - Oct. 26, 2017, 12:18 a.m.

Dear Sir,

very much agree. I have been following this topic with acute interest when a rising star fell. Lorraine Truong, a racer, materials engineer, bike designer, etc. In short a person most of us aspired or aspire to be. Unfortunately there are many examples and most of us know someone personally. 

Furthermore 36 years of extreme sports have  led to my understanding we all fall at one point or another. Not if but when. So firstly I agree with Moritz. Thank you for this humanly comprehensible piece.

While I am not a medical expert I do come from an extensive family of "white coats" and have followed many conversations, and especially sports medicine being a topic which attracts me out of personal motivation.

So here my question, and I believe to have read between the lines here Moritz, but correct me if I am wrong.

Adding cranial pressure to an already active body, I will assume there are going to be long term issues to address here also!?

What I do know from the conversations and items followed on this particular topic we know only one thing for a fact about the brain. Each hit and pressure change causes damage.

I always imagined a safety device such as the one depicted in the film 'Demolition Man' might be the only answer. And even then physics...mass in motion needs to decelerate and dissipate energy or else.

Please correct me if I am wrong, as I mentioned afore, this item is one I feel we have done insufficient work on and rather than plastic bikes we should put the money elsewhere.

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mhaager2
+1 Cam McRae
Moritz Haager  - Oct. 27, 2017, 7:36 p.m.

Yes. There are theoretical risks to this collar. Mostly that of forming blood clots. Any time blood flow slows it's more likely to clot. A clot in the veins draining the brain can cause a type of stroke. I think in a hockey application where you can remove it or loosen it between shifts that's less of a concern, but I can see bikers wearing these for hours at a time. 

The other thing though is that in other areas of human physiology, raising pressure in the venous system tends to result in transient effects.  For example in people with low blood pressure I can get their blood pressure to go up for a bit by raising their legs. That effect will wane after a short while however, probably because veins tend to be stretchy and as they distend the pressure will fall. That's why I wonder if a sudden premptive squeeze by the collar in response to a sudden deceleration might actually be more effective. The theory here is to elevate the intracranial pressure at time of impact. If that is true then you really only need this to be happening for a fraction of a second.  The other cool thing would be that you don't need an actual impact. Just a sudden deceleration or acceleration. As Cam mentioned you don't actually need to hit your head to sustain a concussion. Sudden deceleration/acceleration forces seem to be enough. So if that is true then this should be really applicable.

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